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Billing with National Drug Codes (NDCs)

May 27, 2011

Note: For the most current information on Billing with National Drug Codes (NDCs), go to the Billing with National Drug Codes article posted on 2/01/2012 located in the News & Updates (View All) area of this website.

Blue Cross and Blue Shield of Texas (BCBSTX) requires inclusion of the National Drug Code (NDC) along with the applicable Healthcare Common Procedure Coding System (HCPCS) or Current Procedural Terminology (CPT®) code(s) on claim submissions for unlisted or “Not Otherwise Classified” (NOC) physician-administered and physician-supplied drugs.

BCBSTX currently accepts NDC for billing of all physician-administered and physician-supplied drugs. Effective December 1, 2011 BCBSTX will begin reimbursing claims submitted with an NDC in accordance with the NDC schedule posted on the website under "Drugs".  Including the NDC on claims helps provide a more consistent pricing methodology for payment and will also facilitate better management of drug-associated costs. Physicians are encouraged to begin including the NDC information on claims as soon as possible. For information about how to add the additional NDC and other required elements, please refer to the BCBSTX Provider website. BCBSTX will continue to accept the HCPCS or CPT code elements without NDC information (excluding unlisted or "Not Otherwise Classified" drugs).

Please remember the following to help ensure proper submission of valid NDCs and related information:

  • The NDC must be submitted along with the applicable HCPCS procedure code(s).
  • The NDC must be in the proper format (11 numeric characters, no spaces or special characters).
  • The NDC must be active for the date of service.
  • The appropriate qualifier, unit of measure, number of units, and price per unit also must be included, as indicated below.

ELECTRONIC CLAIM GUIDELINES

Field Name

Field Description

ANSI (Loop 2410) –  Ref Desc

Product ID Qualifier

Enter N4 in this field.

LIN02

National Drug CD

Enter the 11-digit NDC (without hyphens) assigned to the drug administered.

LIN03

Drug Unit Price

Enter the price per unit of the product, service, commodity, etc.

CTP03

NDC Units

Enter the quantity (number of units) for the prescription drug.

CTP04

NDC Unit / MEAS

Enter the unit of measure of the prescription drug given. (Values: F2 – international unit; GR – gram; ML – milliliter; UN – unit)

CTP05-1

If you have any questions about how to include the NDC code on your electronic claims, contact our Electronic Commerce Center at (800) 746-4614.

PAPER CLAIM GUIDELINES

In the shaded portion of the line-item field 24A-24G on the CMS-1500, enter the qualifier N4 (left-justified), immediately followed by the NDC.* Next, enter the appropriate qualifier for the correct 15:38:36 dispensing unit (F2 – international unit; GR – gram; ML – milliliter; UN – unit), followed by the quantity and the price per unit, as indicated in the example below.

*Note: The HCPCS/CPT code corresponding to the NDC is entered in field 24D.

Example:

For additional CMS-1500 details, refer to the National Uniform Claim Committee (NUCC) 1500 Claim Form Reference Instruction Manual, available on the NUCC website at nucc.org.

For more information, continue to visit the News and Updates and Electronic Commerce Alert sections of our website. Updates also will be included in upcoming issues of Blue Review.

Current Procedural Terminology (CPT® ), copyright 2008, by the American Medical Association (AMA). CPT is a registered trademark of the AMA.